Clifford TG, et al. - Researchers pursued an assessment of the incidence and microbiology of urinary tract infection (UTI) within 90 days following radical cystectomy (RC) and urinary diversion in patients with bladder cancer. Data illustrated that UTI was a common complication and served as a cause of readmission following radical cystectomy and urinary diversion. Gram-negative rods were determined to be the common causes of these infections. Based on the yielded data, it was deduced that high comorbidity index was an independent risk factor for postoperative UTI. Nevertheless, the diversion type did not serve this purpose.

Methods

• The enollment consisted of 1,133 patients who underwent RC for bladder cancer between 2003 and 2013.
• Herein, 815 patients (72%) underwent orthotopic diversion, 274 (24%) ileal conduit, and 44 (4%) continent cutaneous diversion.
• Experts recorded 90-day postoperative UTI incidence, culture results, antibiotic sensitivity/resistance and treatment via retrospective review.
• They conducted Fisher’s exact test, Kruskal-Wallis test, and multivariable analysis.

Results

• During the first 90 days postoperatively, 151 urinary tract infections were recorded in 123 patients (11%).
• As per the results, 21/123 (17%) reported multiple infections and 25 (20%) presented with urosepsis in this time span.
• Data revelaed that the most common etiology was gram-negative rods (54% of positive cultures).
• Readmission was noted in the case of 52% of UTI episodes.
• No notable variation was disclosed in UTI rate, etiologic microbiology (Gram-negative rods, Gram-positive cocci, fungi), or antibiotic sensitivity and resistance patterns between diversion groups.
• Findings illustrated resistance to quinolones in 87.5% of Gram-positive and 35% of Gram-negative bacteria.
• A correlation was revealed between Charlson Comorbidity Index > 2 with higher 90-day UTI rate (OR = 1.8, 95% CI 1.1-2.9, p=0.05) and Candida UTI (OR 5.6, 95% CI 1.6-26.5, p=0.04) in multivariable analysis.